Snap-lock for drill sleeve

ABSTRACT

A device for drilling a hole in bone and for inserting bone screws into the drilled hole is provided. The device comprises a trocar, drill sleeve and protection sleeve in a telescopically nested configuration. The drill sleeve and protection sleeve may have an axial locking feature that allows the two pieces to be handled together as a unit by preventing inadvertent separation. The axial locking feature may comprise an integral annular ridge provided on one sleeve that cooperates with an annular groove provided on the other sleeve. One sleeve may also have at least one slot allowing the locking feature to be disengaged prior to separation of the sleeves. The sleeves may be easily separated with one hand by the user by the application of an axial separation force between a pair of flanges provided with the sleeves, and by a radial compression force applied to at least a portion of the drill sleeve.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. application Ser. No.10/849,714 filed May 19, 2004, entitled SNAP-LOCK FOR DRILL SLEEVE, theentire content of which application is expressly incorporated herein byreference thereto.

FIELD OF THE INVENTION

The present invention is related to a drill sleeve system. Moreparticularly, the invention is related to a snap lock design forprovisionally retaining a drill sleeve to a screw insertion sleeve.

BACKGROUND OF THE INVENTION

Orthopedic fixation devices such as plates are frequently coupled tobone with fasteners inserted through holes in the device. For fracturesof the long bones such as the humerus or the femur, fractures may betreated by inserting an elongated member into a channel reamed in theintramedullary canal. This elongated member, or “intramedullary nail” asit is known in the art, may provide stability to the bone until thefractured bone segments heal together. Intramedullary nails may befastened to the bone in which they reside using screws inserted throughpre-formed holes in the nail. Corresponding holes may be drilled in theadjacent bone to allow easier insertion of the screws in the bone. Theseholes can be formed with the aid of a drill guide aligned with thetargeted screw hole. A drill may be introduced through the drill guideis thus guided through the screw hole to drill a hole in the boneunderlying the screw hole.

In an effort to reduce the total number and length of incisions createdwhen installing the intramedullary nail and inserting the securingfasteners, the drilling and screw insertion process can be performedpercutaneously. Thus, an incision may be made in the skin overlying thebone, and a trocar may be inserted into the incision and used toseparate the soft tissue to create an initial passage down to the bone.A drill may be inserted through the drill sleeve and used to form a holein the bone as previously described. A screw insertion sleeve maythereafter be inserted through the passage and used to facilitateengagement of the screw with the screw hole and bone. Advantageously,these three pieces (trocar, drill sleeve, screw insertion sleeve) may beprovided as a single unit to facilitate handling and use by the surgeon.Thus, the three pieces may be nested within each other and inserted as asingle unit.

To further facilitate use of these three-piece units, at least two ofthe pieces may be provided with features aimed at preventing separationof the individual pieces while they are being handled by the user. Forexample, snap rings, ball detents, or threads may be used to secure thepieces together. To remove one piece from the other (e.g. to remove thedrill sleeve from the screw-insertion sleeve), the user may pull thepieces apart (in the case of a snap-ring or ball-detent) or may unthreadthe pieces (where threaded pieces are provided).

Snap-ring locking devices may be difficult to sterilize, and threadedpieces may be difficult to handle in the surgical environment. Thusthere exists a need for a multiple piece drill sleeve system having asimple, easy to sterilize design for provisionally retaining at leasttwo pieces of the system with respect to each other, and which allowseasy separation of those pieces when desired by the user.

SUMMARY OF THE INVENTION

An orthopedic system is disclosed comprising a first sleeve memberhaving an outer surface and an inner surface defining a longitudinalbore and a surface; and a second sleeve member having an outer surfaceand an inner surface defining a longitudinal bore, where the secondsleeve member may further be configured to be at least partly receivedwithin the bore of the first sleeve member. The longitudinal bore of oneof the first and second sleeves may be configured to receive a drill bittherethrough to drill a hole in bone. Further, one of the first andsecond sleeve members may further comprise a protrusion and the othermay comprise a corresponding recess, the protrusion and recess beingco-operable to provisionally axially lock the first and second sleevemembers together when the second sleeve member is at least partlyreceived within the bore of the first sleeve member. The second sleevemay be dis-engageable from the first sleeve through the application ofan axial separation force between the first and second sleeves and aradial compression force to at least a portion of the second sleeve.

The system may also comprising a trocar configured to be received withinthe longitudinal bore of the second sleeve. The first and second sleevemembers further may each have a proximal end comprising a flange memberand a distal end comprising a tapered tip region. The longitudinal boreof the first sleeve may further be configured to receive a driver andbone fastener therethrough to allow insertion of the fastener into bonein a direction along the longitudinal axis of the bore. Moreover, thetapered tip of at least one of the first or second sleeve membersconfigured to align with a fastener hole in a bone fixation element. Thebone fixation element may be a bone plate or an intramedullary nail.

The protrusion may be integrally formed with the associated sleeve, andin one embodiment may comprise at least one circumferential ridge. Therecess may comprise at least one circumferential groove corresponding tothe at least one ridge. The protrusion further may comprise first andsecond tapered surfaces.

The second sleeve may comprise at least one longitudinal slot disposedbetween the inner and outer surfaces of the sleeve, the slot runningfrom at least one end of the sleeve and having a length, the slotfurther configured to render at least a portion of the sleeve radiallyflexible.

The at least one slot may divide a first end of the sleeve into firstand second halves, wherein pressing the first and second halves towardeach other may disengage the ridge from the recess, thereby allowing thefirst and second sleeves to be axially engaged with, or disengaged from,each other.

The second sleeve may have two longitudinal slots diametrically disposedwith respect to each other about the circumference of the sleeve. Theprotrusion may comprise at least one tapered surface configured tofacilitate radial compression of the second sleeve when the sleeve isinserted into the bore of the first sleeve.

The first and second sleeves and the trocar may be color coded toprovide a visual indication of the size of a bone screw that can bereceived through the bore of the first sleeve.

The outer surface of the first sleeve may be configured to be receivedwithin the bore of an aiming arm of an intramedullary nail to align thesleeve with a targeted fastener hole in a portion of the intramedullarynail.

An orthopedic system is provided comprising a first sleeve havingproximal and distal ends, a longitudinal axis and inner and outersurfaces.

A second sleeve may be provided having proximal and distal ends, alongitudinal axis, and inner and outer surfaces, where the inner surfaceis configured to receive at least a portion of the first sleeve. Theinner surface may further be configured to receive a bone fastener anddriver for inserting the fastener into the hole drilled in bone. Theinner surface of at least one of the first and second sleeves may beconfigured to receive a drill bit for drilling a hole in bone. At leasta portion of the first sleeve may be slidably receivable within at leasta portion of the second sleeve.

One of the second sleeve inner surface and the first sleeve outersurface may comprise a projection, and the other may comprise acorresponding recess so that when the first sleeve is received withinthe second sleeve, the projection and recess may cooperate to releasablyaxially engage the first sleeve with the second sleeve.

The projection may be integrally formed with the associated sleeve. Theprotrusion may also comprise at least one circumferential ridge, or aplurality of discrete protruding elements. The recess may comprise atleast one circumferential groove corresponding to the at least oneridge. The protrusion may comprise first and second tapered surfacesconfigured to engage a portion of the inner surface of the secondsleeve.

The sleeves may be disengageable from each other by applying an axialseparation force between the first and second sleeves and a radialcompression force to at least a portion of the first sleeve.

The system may further comprise a trocar configured to be receivedwithin the longitudinal bore of the first sleeve. The sleeves furthermay each have a proximal end comprising a flange member and a distal endcomprising a tapered tip region. The tapered tip of at least one of thefirst or second sleeves may be configured to align with a fastener holein a bone fixation element. The bone fixation element may be a boneplate or an intramedullary nail.

The first sleeve may comprise at least one longitudinal slot disposedbetween the inner and outer surfaces of the sleeve, the slot runningfrom at least one end of the sleeve and having a length, the slotfurther configured to render at least a portion of the sleeve radiallyflexible. The at least one slot may divide a first end of the firstsleeve into first and second halves, wherein when the first sleeve isfully received within the second sleeve, pressing the first and secondhalves toward each other disengages the ridge from the recess, therebyallowing the first sleeve to be removed from the second sleeve.

When the first sleeve is inserted into the second sleeve, the firsttapered surface may cooperate with the inner surface of the secondsleeve to radially compress the first and second halves together. Thefirst sleeve may have two longitudinal slots diametrically disposed withrespect to each other about the circumference of the sleeve. Theprotrusion may comprise at least one tapered surface configured tofacilitate radial compression of the first sleeve when the sleeve isinserted into the bore of the second sleeve.

The first and second sleeves and the trocar may be color coded toprovide a visual indication of the size of a bone screw that can bereceived through the bore of the first sleeve.

Moreover, the outer surface of the first sleeve may be configured to bereceived within the bore of an aiming arm of an intramedullary nail toalign the sleeve with a targeted fastener hole in a portion of theintramedullary nail.

A method of drilling a hole in bone is provided, comprising: (a)providing a drill sleeve and protection sleeve combination, the drillsleeve telescopically receivable within at least a portion of theprotection sleeve, the drill sleeve having an inner surface forreceiving a drill bit for drilling a hole in a bone, the drill sleevehaving an outer surface comprising one of a projection and a recessconfigured to engage a corresponding recess or projection disposed on aninner surface of the protection sleeve to provisionally axially lock thesleeves together; wherein the drill and protection sleeve are separablefrom each other through the application of an axial separation forcebetween the sleeves and a radial compression force to at least a portionof the drill sleeve; (b) advancing the drill sleeve and protectionsleeve combination through an incision in a patient; (c) advancing thedrill sleeve and protection sleeve to align with a bone fixation elementoverlying a portion of the bone; (d) inserting a drill bit through thedrill sleeve and advancing the drill bit to engage bone; (e) rotatingthe drill to produce a hole in the bone; (f) removing the drill bit fromthe drill sleeve; and (g) applying an axial separation force between thedrill sleeve and the protection sleeve and applying a radial compressionforce to a portion of the drill sleeve to disengage the two.

The drill sleeve and protection sleeve further may comprise a trocarconfigured to be received within the longitudinal bore of the drillsleeve. The sleeves further each have a proximal end comprising a flangemember and a distal end comprising a tapered tip region. The bonefixation element may be a bone plate or an intramedullary nail. Theprojection may be integrally formed with the associated sleeve. Theprojection may comprise a plurality of discrete protruding elements. Theprojection may comprise at least one circumferential ridge. The recessmay comprise at least one circumferential groove corresponding to the atleast one ridge. The protrusion may comprise first and second taperedsurfaces configured to engage a portion of the recess.

The drill sleeve may comprise at least one longitudinal slot disposedbetween the inner and outer surfaces of the sleeve, the slot runningfrom at least one end of the sleeve and having a length, the slotfurther configured to render at least a portion of the sleeve radiallyflexible the at least one slot may divide a first end of the drillsleeve into first and second halves so that when the drill sleeve isfully received within the screw insertion sleeve, pressing the first andsecond halves toward each other may disengage the protrusion from therecess, thereby allowing the drill sleeve to be removed from the screwinsertion sleeve.

The method may comprise the additional steps of: (g) inserting a bonefastener and screwdriver through the protections sleeve; and (h) drivingthe bone fastener into the hole in the bone to fix the bone fixationelement to the bone.

The method may further comprising the step, between steps (a) and (b),of: inserting the outer surface of the protection sleeve into a bore inan aiming arm attached to an intramedullary nail; step (c) may furthercomprise advancing the protection sleeve and drill sleeve through thebore in the aiming arm to align with a fastener hole in the bonefixation element; and step (e) comprises drilling a hole in the bonethrough the fastener hole in the intramedullary nail.

The method may further comprising the steps of: (h) inserting a bonefastener and screwdriver through the protection sleeve; (i) driving thebone fastener into the hole in the bone to fix the bone fixation elementto the bone; and (1) removing the protection sleeve from the patient.

BRIEF DESCRIPTION OF THE DRAWINGS

Preferred features of the present invention are disclosed in theaccompanying drawings, wherein similar reference characters denotesimilar elements throughout the several views, and wherein:

FIG. 1 is a cross sectional assembled view of a protection sleeve, drillsleeve and trocar device of the present invention.

FIGS. 2 a and 2 b are side and detail views of the trocar element of thedevice of FIG. 1;

FIGS. 3 a through 3 e are side, top, partial detail and detail views,respectively, of the drill sleeve of the device of FIG. 1;

FIGS. 4 a, 4 b and 4 c are side, cross-section and detail cross-sectionviews, respectively, of the protection sleeve of the device of FIG. 1;

FIGS. 5 a and 5 b are side and cross-section views of the drill sleeveof FIG. 3 a employing an alternative retention feature design;

FIGS. 6 a and 6 b are side and cross-section views of the protectionsleeve of FIG. 4 a for use with the drill sleeve retention featuredesign of FIGS. 5 a and 5 b;

FIG. 7 is a side view of an exemplary drill bit for use with the deviceof FIG. 1;

FIG. 8 is a side view of an exemplary bone screw for use with the deviceof FIG. 1;

FIG. 9 is a cross-section view of the device of FIG. 1 without thetrocar, and with the drill bit of FIG. 7 inserted through the drillsleeve;

FIG. 10 is a cross-section view of the system of FIG. 1 without thetrocar and drill sleeve, and with a screw and screwdriver insertedthrough the protection sleeve;

FIGS. 11 a through 11 c are perspective views of the device of FIG. 1being used with an aiming arm of an intramedullary nail assemblyinserted in a femur;

FIGS. 12 a and 12 b are side and cross section views of a wire guidesleeve for use with the protection sleeve of FIGS. 4 a-c;

FIG. 13 is a partial cross section view of a drill used with theprotection sleeve of FIGS. 4 a-c;

FIG. 14 is a side view of a guide wire for use with the protectionsleeve of FIGS. 4 a-c and the wire guide sleeve of FIGS. 12 a-b.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

A drilling and screw insertion sleeve device is disclosed for use ininstalling fasteners for securing orthopedic fixation devices, such asbone plates, intramedullary nails, and the like, to bone segments of thehuman anatomy. Such fixation devices may be used to repair fracturedbones or may be installed to protect against the fracturing of weakbones. FIG. 1 shows an exemplary device 1 for such use, comprising atrocar 10, a drill sleeve 20 and a protection sleeve 30. As illustrated,the trocar 10, drill sleeve 20 and protection sleeve 30 are in a nestedconfiguration which allows them to be introduced through a surgicalincision as a single unit. Thus, when the device 1 is used for drillingholes and placing screws in bone, the device 1 may be inserted through asingle incision made through the patient's skin immediately overlyingone or more bone screw holes of a plate, nail, etc. The individualelements of the system may then be removed as necessary to perform thedesired procedure. For example, the trocar 10 may be removed after thedevice 1 has been appropriately placed in contact with the patient'sbone or the screw hole of a fixation device.

As shown in FIG. 1, the device 1 has a proximal user end 2, a distalincision end 3, and a generally cylindrical longitudinal central portion4 generally formed by the outer surface of the protection sleeve 30. Theproximal end 2 is configured for easy grasping by the user, and thedistal end 3 may have a tapered configuration to facilitate insertioninto an incision in the patient.

Referring to FIGS. 2 a and 2 b, the trocar 10 comprises a rod-likemember having proximal and distal ends 110, 120 and a cylindrical centerportion 130 having an outer diameter “td,” a longitudinal axis “A-A,”and a length “tl.” The proximal end 110 may comprise a flange element112 having an increased diameter “tfd,” and an outer gripping surface114 configured to be easily grasped by a user. The flange element 112may further comprise a proximal end face 116 and a distal face 118. Theproximal end face 116 may be configured to receive a user input force,such as may be applied by the thumb or palm of the hand, while thedistal face 118 may be configured to engage a proximal face 214 of thedrill sleeve flange 212 to transmit the applied user input forcethereto.

The trocar flange element 112 may have one or more annular grooves 119that have a band of color applied to distinguish the trocar as being ofa particular size. That is, since the inventive system may be providedin any of a variety of sizes, it may be advantageous to provide a simplecolor-coding of the device elements to provide a clear visual indicationto the user of the system size. Thus, groove 119 may be provided with aband of color that matches similar color bands provided on the drillsleeve 20, protection sleeve 30, and drill 40 of the same system size.Color may be applied to the groove 119 by painting or other appropriatetechnique.

The trocar distal end 120 may be tapered to allow easier insertion intothe incision in the patient. The taper may form an angle θ with respectto the longitudinal axis “A-A,” which in the illustrated embodiment isabout 30°, although other angles may be provided. The distal end 120 mayhave a tip portion 122 forming a sharp point to further facilitatemovement of the trocar 10 (as well as drill sleeve 20 and protectionsleeve 30) 1 through the surrounding tissue. In use, the tip portion 122may be used to separate the soft tissue as it is being pressed into andthrough the incision.

Referring to FIGS. 3 a through 3 e, an exemplary drill sleeve 20 isshown having proximal and distal ends, 210, 220, a central cylindricalportion 230 having a longitudinal axis “B-B”, and a length “dsl.” Thedrill sleeve 20 further may have an outer cylindrical surface 232 havinga diameter “dod,” and an inner cylindrical surface 234 having a diameter“did” defining a longitudinal bore 236 running along the length “dsl.”

The drill sleeve bore 236 may be sized to accept the cylindrical centerportion 130 of trocar 10 during insertion of the sleeve 20 into thepatient as part of system 1, and as illustrated in FIG. 1. The bore 236may also be sized to accept an appropriately sized drill bit 40 (FIGS.7, 9) to allow drilling of underlying bone through the drill sleeve 20along longitudinal axis “B-B” once the sleeve 20 has been introducedthrough the incision.

The proximal end 210 of the drill sleeve 20 may comprise a flange 212having a diameter “dsfd” that is greater than the sleeve outer diameter“dod.” The flange 212 may further have a proximal end face 214configured to engage the distal end face 118 of the trocar 10 when thetrocar is fully inserted into the drill sleeve 20 (see FIG. 1). Theflange 212 may further have a distal end face 216 configured to engage aproximal annular end face 314 of the protection sleeve 30 (see FIGS. 1and 4 b), as will be described in more detail later.

As shown in FIG. 3 a, to facilitate insertion of the trocar 10 withinthe drill sleeve 20, bore 236 may taper slightly outward at a pointimmediately adjacent the sleeve proximal end 210.

The drill sleeve flange 212 may have an outer gripping surface 218configured to allow easy grasping by a user. In the illustratedembodiment, the outer diameter of the proximal end face 214 is largerthan the outer diameter of distal end face 216, such that grippingsurface 218 disposed therebetween is angled to face slightly in thedistal direction. Gripping surface 218 is also slightly concave to moreclosely conform to the user's fingers as they may be applied to pull thedrill sleeve 20 out of engagement with protection sleeve 30.

The drill sleeve distal end 220 may be tapered to allow easier insertioninto the incision in the patient. The taper may form an angle α withrespect to the longitudinal axis “B-B,” which in the illustratedembodiment is about 30°, and which substantially matches angle θ of thetrocar distal end 120. The length “dsl” may be such that when the trocar10 is inserted through the bore 236 of the drill sleeve, the distal tip122 extends a distance “x” distally beyond the distal end 220 of thedrill sleeve 20 (see FIG. 1). This distance “x” may be selected so thatthe tapered ends 122, 220 of the trocar 10 and drill sleeve 20correspond to form one relatively smooth tapered surface which mayfacilitate the insertion and advancement of the two pieces into apatient incision.

The drill sleeve 20 may further incorporate a locking feature toprovisionally axially retain the drill sleeve within the protectionsleeve 30 during handling and installation. This locking feature may beeasily overcome by the application of finger pressure between the drilland protection sleeve flanges 212, 312 (FIG. 4 a), as previously noted.In the embodiment illustrated in FIGS. 3 a & 3 c, the locking featurecomprises a circumferential ridge 2000 located adjacent proximal endflange 212. As illustrated in FIG. 3 c, ridge 2000 may have first andsecond tapered surfaces 2010, 2020 and a top surface 2030 having aheight “rh”. The first and second tapered surfaces 2010, 2020 may beoriented at taper angles γ, σ with respect to the longitudinal axis“B-B” of the drill sleeve 20. The tapers 2010, 2020 may allow smoothengagement and disengagement of the circumferential ridge with aninternal recess 3000 (FIG. 4 c) of the protection sleeve 30, as will bedescribed in more detail later. To further facilitateengagement/disengagement, one or both of the tapered surfaces may alsobe slightly concave. Thus, when the drill sleeve 20 is inserted into theprotection sleeve 30, the first tapered surface 2010 may engage theinner surface 334 of the protection sleeve 30 to provide a smoothcompression of the proximal end 210 of the drill sleeve 20. Once theridge 2000 is fully engaged with the recess 3000, the second taperedsurface 2020 may contact the proximal end wall 3010 of the recess 3000in the protection sleeve 30 to prevent the drill sleeve 20 from fallingout of the proximal end 210 of the protection sleeve 30 during normalhandling.

In one embodiment (FIG. 3 c), the second surface taper angle σ may begreater than the first surface taper angle γ to result in a relativelylow required engagement force between the pieces 20, 30 and a slightlyhigher disengagement force for separation of the pieces. It is notedthat although the ridge 3000 is illustrated as having unequal first andsecond taper angles γ, σ, the drill sleeve 20 could be provided withequal taper angles (see FIG. 5 b).

γ may be from about 5 degrees to about 90 degrees, and in oneembodiment, γ is about 30 degrees. σ may be from about 1 degree to about90 degrees, and in one embodiment, σ is about 5 degrees. Ridge height“rh” may be from about 0.2 mm to about 1.0 mm, and in one embodiment isabout 0.4 mm.

As shown in FIG. 3 a, a pair of longitudinal slots 2050, 2060 may beprovided in diametrically opposed relationship in the drill sleeveproximal end 210 to allow compression of the drill sleeve 20 so that thecircumferential ridge 2000 may engage the protection sleeve recess 3000.Thus, the slots 2050 may divide the proximal end 210 of the drill sleeveinto first and second opposing halves 2110, 2120 that may be flexedtoward each other to temporarily reduce the outer dimension of thecircumferential ridge 2000 during installation and removal of the drillsleeve 20 from the protection sleeve 30.

As shown in FIG. 3 a, the slots 2050, 2060 may run from the drill sleeveproximal end 210 to a location between the sleeve proximal and distalends 210, 220. The slots 2050, 2060 may have a length “sl” and a width“sw,” and at their distal ends may be provided with a stress-reducingenlarged cutout 2070, which in the illustrated embodiment is a circularcutout. Slot length “sl” may be from about 20 mm to about 150 mm, and inone embodiment is about 65 mm. Slot width “sw” may be from about 0.5 mmto about 3.0 mm, and in one embodiment is about 1.0 mm.

It is noted that while the drill sleeve of FIG. 3 a has been describedas having a pair of slots 2050, 2060, drill sleeve 20 could be providedwith one or more slots, as desired. Further, where more than one slot isemployed, the slots may have different lengths and/or different widths.Furthermore, the slots may have varying widths along their respectivelengths.

As shown in FIGS. 3 a and 3 e, side flats 2080, 2090 may be provided onthe outer surface 232 of the drill sleeve adjacent the drill sleeveproximal end 210. These flats 2080, 2090 may be disposed at 180 degreeintervals, and may be centered on the slots 2050, 2060 to furtherfacilitate insertion of the drill sleeve 20 into the protection sleeve20. Since the slots 2050, 2060 only allow compression of the drillsleeve 20 in one dimension, the flats 2080, 2090 eliminate the remaininginterference between the circumferential ridge 2000 and the innersurface 334 of the protection sleeve 30 adjacent to the slots 2050,2060. It is noted that providing the drill sleeve 20 with more than twoslots may allow the sleeve to be compressed in two dimensions, and thusthe side flats 2080, 2090 may not be required.

As with the trocar 10, the drill sleeve 20 may be color-coded todistinguish the sleeve as corresponding to a particularly sized drillbit. Thus, the central cylindrical portion 230 may have an annulargroove 238 formed in the outer surface 232 into which a band of colormay be applied. The color applied may match the color applied to atrocar 10 that is sized to be received within the bore 236 of the drillsleeve 20.

Referring to FIGS. 4 a through 4 c, an exemplary protection sleeve 30 isshown having proximal and distal ends, 310, 320, a central cylindricalportion 330 having a longitudinal axis “C-C”, and a length “psl.” Theprotection sleeve 30 further may have an outer cylindrical surface 332having a diameter “pod,” and an inner cylindrical surface 334 having adiameter “pid” defining a longitudinal bore 336 running along the length“psl.”

The protection sleeve bore 336 may be sized to accept the cylindricalcenter portion 230 of drill sleeve 20 during insertion of the sleeves20, 30 into the patient as part of system 1, and as illustrated inFIG. 1. The bore 336 may also be sized to accept an appropriately sizedscrew 50 and screwdriver 60 (FIG. 10) to facilitate insertion of thescrew into the underlying bone through the protection sleeve 30 alongthe sleeve longitudinal axis “C-C” once the sleeve 30 has beenintroduced through the incision. Thus, the inner diameter “pid” may beabout 1.0 mm to about 17.0 mm to allow insertion of screws, spiralblades or helical blades therethrough. Further description regardingsuch blades is provided in co-pending U.S. nonprovisional patentapplication Ser. No. 10/269,976 to Roth et al., filed Oct. 15, 2002 andtitled “Orthopedic Implant Insertion Instruments,” the entirety of whichapplication is incorporated herein by reference. Specifically, theprotection sleeve 30 may receive screws having major diameters of fromabout 1 mm to about 8 mm and having head diameters of about 1.0 mm toabout 12.0 mm.

The proximal end 310 of the protection sleeve 30 may comprise a flange312 having a diameter “psfd” that is greater than the sleeve outerdiameter “pod.” The flange 312 may further have a proximal end face 314configured to engage the distal end face 216 of the drill sleeve 20 whenthe drill sleeve is fully inserted into the protection sleeve 30 (seeFIG. 1). The flange 312 may further have a distal end face 316configured to allow gripping by a user.

The protection sleeve flange 312 may further have an outer grippingsurface 318 disposed between the proximal and distal end faces 314, 316and configured to allow easy grasping by a user. In the illustratedembodiment, the outer diameter of the proximal end face 314 is smallerthan the outer diameter of distal end face 316, such that grippingsurface 318 disposed therebetween is angled to face slightly in theproximal direction. Gripping surface 318 also may be slightly concave tomore closely conform to the user's fingers as they may be applied tohold the protection sleeve 30 while pulling the drill sleeve 20 out ofengagement with protection sleeve 30.

As shown in FIGS. 4 b and 4 c, and previously described in relation tothe circumferential ridge 2000 of drill sleeve 20, the protection sleeve30 may further have a recess 3000 disposed in the bore 336 adjacent thesleeve proximal end 310. This recess 3000 may be configured to engagethe circumferential ridge 2000 of the drill sleeve 20 when the drillsleeve is fully inserted into the protection sleeve 30. The recess 3000may have a diameter “rd,” and proximal and distal end surfaces 3010,3020 that provide a transition between the recess 3000 and the bore 336.Recess diameter may be sized to provide a recess depth “rdpth” of fromabout 0.2 mm to about 1.0 mm to provide the desired interference andlocking with circumferential ridge 2000. In one embodiment, the recessdepth “rdpth” is about 0.6 mm. Further, to facilitate insertion of thedrill sleeve 20 into the protection sleeve 30, the bore 336 may taperslightly outward immediately adjacent the sleeve proximal end 310.

The protection sleeve distal end 320 may be tapered to allow easierinsertion into the incision in the patient. The taper may form an angleβ with respect to the longitudinal axis “C-C,” which in the illustratedembodiment is about 30°, and which substantially matches angles θ and αof the trocar and drill sleeve distal ends 120, 220. Further, the length“psl” may be such that when the drill sleeve 20 is inserted through thebore 336 of the protection sleeve, the distal end 220 extends a distance“y” distally beyond the distal end 320 of the protection sleeve 30 (seeFIG. 1). This distance “y” may be selected so that the tapered ends 122,220, 320 of the trocar 10, drill sleeve 20 and protection sleevecorrespond to form one relatively smooth tapered surface which mayfacilitate the insertion and advancement of the two pieces into apatient incision.

FIGS. 5 a-5 c show a drill sleeve 1200 having an alternative provisionalretention feature comprising a raised circumferential ridge 1222configured to engage a corresponding recess 1322 in an alternativeprotection sleeve 1300 (see FIGS. 6 a, 6 b). The ridge 1222 may bedisposed on the outer surface 1232 of the sleeve 1200 adjacent thedistal end face 1216 of flange 1212. As shown in FIGS. 5 a-5 c the drillsleeve 1200 may have a longitudinal slot 1224 formed in the proximal end1210 and extending distally to intersect with an elongated window 1226disposed between the outer and inner surfaces 1232, 1234 of the sleeve.This combination of slot 1224 and window 1226 provides the desiredflexibility to the proximal end 1210 of the drill sleeve 1200 to allowit to be compressed so that the drill sleeve 20 can be received withinthe protection sleeve 30 as described previously in relation to thedrill sleeve 20 of FIG. 3 a.

FIGS. 6 a-6 c show a protection sleeve 1300 for use with the drillsleeve 1200 of FIGS. 5 a-5 c in which circumferential recess 1322 isdisposed in inner surface 1334 adjacent proximal end flange 1312. Recess1322 may be configured to receive ridge 1222 of the drill sleeve 1200when the drill sleeve is inserted fully into the protection sleeve 1300as described previously in relation to the drill sleeve 20 andprotection sleeve 30 of FIGS. 3 a and 4 a.

Furthermore, it should be noted that the drill sleeve 1200 of FIGS. 5a-5 c and the protection sleeve 1300 of FIGS. 6 a-6 c may furtherincorporate any or all of the other features previously described inrelation to the drill sleeve 20 and protection sleeve 30 of FIGS. 3 aand 4 a (e.g. distal end taper, dimensions, color-coding, flangeconfigurations, etc).

It should also be noted that although the invention has been describedas having the projection formed on the drill sleeve and the recessformed in the protection sleeve, this arrangement may be reversed. Thus,a projection or projections may be provided on the inner surface of theprotection sleeve and the corresponding recess or recesses may beprovided on the drill sleeve outer surface.

Furthermore, the projection provided on the drill sleeve (oralternatively on the protection sleeve) may be formed by machining.Thus, if the sleeve itself is machined from a single piece of material,the projection may be formed during the general machining process.Alternatively, the projection may be provided by depositing a weld beador fillet about the circumference of the drill sleeve/protection sleeveand then machining or grinding the bead or filled to the desired shape.Further, the projection may comprise a series of raised rivets orapplied nubs integrated into the surface of the drill guide/protectionsleeve and configured to engage the recess of the protection sleeve.

In yet another alternative embodiment, the projection could be formedusing a short sleeve or annular ring applied to the drill sleeve orprotection sleeve. Such an arrangement may simplify the machining of thedrill sleeve/protection sleeve, since instead of being machined-in, thering could be fixed in place using an appropriate means, includingwelding, brazing, bonding, shrink fit or press fit to the associatedsleeve.

FIG. 7 shows an exemplary drill bit 40 for use with the device 1. Thedrill bit 40 may have a proximal coupling end 410, a distal drilling end420 and a central cylindrical shaft portion 430 disposed therebetween. Aset of calibration marks 440 may be provided along at least a portion ofthe shaft 430. These calibration marks may be used to determine thedepth to which the drill has been driven into bone. Thus, when the drillbit 40 is inserted into the drill sleeve 20 as shown in FIG. 9, the usermay read the calibration mark 440 located directly adjacent the drillsleeve flange proximal face 214 to determine the distance beyond thedistal end 220 of the drill sleeve 20 that the distal cutting end 420 ofthe drill 40 has been extended. This arrangement thus allows a quick andeasy manner of determining drilling depth.

FIG. 8 shows an exemplary fastener for use with the device 1 in whichbone screw 50 has a head 510 and a threaded shank 520, the head having amaximum diameter “msd” that is slightly smaller than the inner diameter“pid” of protection sleeve 30. The head may further have a drive recess530 configured to receive the driving tip 610 of screwdriver 60 (seeFIG. 10) to drive the bone screw 50 into bone. Thus, as illustrated inFIG. 3, protection sleeve 30 is sized to receive bone screw 50 andscrewdriver 60 to allow the screw 50 to be driven into the underlyingbone via protection sleeve 30 and along axis “C-C.”

A method of using the invention to engage a bone fastener with afixation device and underlying bone is also provided. To assemble thedevice 1, drill sleeve 20 may be inserted into protection sleeve 30until the circumferential ridge 2000 of the drill sleeve engages theproximal end 310 of the protection sleeve. Thereafter, the applicationof force against the drill sleeve 20, while holding the protectionsleeve 30 steady, may cause the proximal end 210 of the drill sleeve tocompress along slots 2050, 2060 allowing the circumferential ridge 2000to pass into engagement with recess 3000 in the protection sleeve 30.Once the ridge 2000 and recess 3000 are engaged, the sleeves 20, 30 areprovisionally axially locked together. The trocar 10 may then beinserted into the drill sleeve 20.

The assembled device 1 (FIG. 1) may then be inserted into an incision inthe patient overlying a targeted bone screw hole of a fixation element.The user may insert the pointed end 3 of the device 1 into the incision,pressing the device down through the tissue by applying force to thedevice flanges 112, 212, 312. The tapered distal end surfaces 122, 220,320 may serve to separate the tissue, facilitating passage of the devicetherethrough. Once the distal end 3 of the device 1 contacts the bone,the trocar 10 may be removed, and a drill bit may be 40 inserted throughthe bore 236 of the drill sleeve. The drill bit 40 may be advanced untilthe cutting end engages bone, and drilling may be performed until adesired depth is reached, as indicated by calibration marks 440 on thedrill bit. The drill bit 40 may be removed from the drill sleeve 20, anddrill sleeve 20 may be removed from the protection sleeve by squeezingtogether the arms 2110, 2120 of the proximal flange 212 and pulling thedrill sleeve 20 up and away from the protection sleeve 30. Anappropriately sized bone screw 50 may then be engaged with the end of ascrewdriver 60 and the two may be inserted into the bore 336 of theprotection sleeve 30 via the sleeve proximal end 310. The screw 50, andscrewdriver 60 may then be advanced through the sleeve to engage thefixation device and/or the drilled hole in the bone. The screwdriver 60may then be used to drive the bone screw into the bone hole, fixing thefixation device to the bone. Thereafter, the screwdriver 60 andprotection sleeve 30 may be removed from the incision and the incisionmay be sutured closed.

FIGS. 11 a-11 c illustrate the use of the invention for installinglocking screws in the shaft of an intramedullary nail. As illustrated,intramedullary nail 70 is inserted in the intramedullary canal of apatient femur 80. Aiming arm 90 is engaged with the nail 70, and is usedto guide the trajectory of the locking screw 50 to precisely align withone or more pre-formed fixation holes 72 in the nail 70. Furtherdescription of the aiming arm and associated instruments is provided inco-pending non-provisional U.S. patent application Ser. No. 09/978,002to Roth filed Oct. 17, 2001 and titled “Bone Fixation Systems,” theentirety of which application is incorporated herein by reference.

Thus, the device 1 may be inserted into an appropriate bore 92 in theaiming arm 90 corresponding to a fixation hole 72 in the nail 70. Theouter surface 332 of the protection sleeve 30 may slide within theaiming arm bore 92 to align the device 1 with the fixation hole 72. Anincision may be made in the skin over the insertion point for the device1, and by applying a force to the device flanges 112, 212, 312, thedevice may be driven through the incision and into alignment with thetargeted fastener hole. The trocar 10 may be removed, and drilling andscrew insertion functions may be performed as previously described.

Shown in FIGS. 12 a & b is a wire guide sleeve 400 that may be usedtogether with the protection sleeve 30 of FIGS. 4 a-c to create aninitial opening in bone for insertion of an intramedullary nail.Alternatively, the sleeves 400, 30 may be used for inserting a spiralblade or helical blade into a fractured femoral head to connect the headto the associated femoral shaft. A large pre-drilled bone hole may berequired to receive such large fixation devices (e.g. from about 8 mm toabout 17 mm), and thus the protection sleeve may be used for receivingand guiding the large sized drill bit 500 (see FIG. 13) for drilling thehole in the bone. The wire guide sleeve 400 may be used for engaging aguide wire 600 (see FIG. 14) for aligning the sleeves 400, 30 with thebone segments to be fixed. The guide wire 600 may be pre-inserted in atleast one bone segment to provide precise alignment of the sleeves 400,30 to ensure the drilled bone hole will have the precise trajectorydesired by the surgeon. A bone hole thus prepared may ensure that theinstalled fixation device engages the bone portions in a manner thatwill best facilitate fusion of the fractured bone segments.

The wire guide sleeve 400 may have any or all of the features of thedrill sleeve 20 described in relation to FIGS. 3 a-e (e.g. tapereddistal end 401, proximal flange element 402, generally cylindrical bodyportion 403, color coding, etc.). The wire guide sleeve 400 may alsocomprise any of the locking features as described in relation to FIGS. 3a-e for provisionally axially locking the wire guide sleeve 400 to theprotection sleeve 30. In the illustrated embodiment, the wire guidesleeve 400 has a circumferential ridge 404 having all of the featuresdescribed in relation to circumferential ridge 2000 of drill sleeve 20(see FIG. 3 c), and also has longitudinal slots 406, 407 having all thefeatures described in relation to slots 2050, 2060 of the drill sleeve20 (see FIG. 3 a). Further, the wire guide sleeve 400 may have a distalinner surface portion 405 sized and configured to coaxially receive theguide wire 600. In the illustrated embodiment, the distal inner surfaceportion may have an inner diameter “wgid” of about 3.3 mm, which mayaccept a standard 3.0 mm guide wire. The outer surface diameter “wgod ”of the wire guide sleeve 400 may be from about 4 mm to about 17 mm, toallow it to be slidably received within the longitudinal bore 336 of theprotection sleeve 30. Thus, the wire guide sleeve 400 may be receivedwithin the protection sleeve 30 and the assembled sleeves may thusreceive the guide wire 600. It is noted that the indicated dimensionsare provided for purposes of illustration only, and that other sizes,both larger and smaller, are also contemplated.

To use the combination of the protection sleeve 30/wire guide sleeve 400for forming an opening in a femur into which an intramedullary nail maybe inserted, the surgeon may first make an incision in the patient'sskin to the depth of the bone. The protection sleeve 30, guide sleeve400 and trocar 10 may be nested together as previously described inrelation to FIG. 1 and driven through the incision down to the bone. Thetrocar 10 may then be removed and a guide wire inserted through thecannulation 405 in the wire guide sleeve 400 and advanced into the boneunder x-ray or fluoroscopic observation. The guide wire 600 may have athreaded or drilling tip 602 that may allow the surgeon to positivelyengage the guide wire 600 to the bone. Once the guide wire is properlypositioned, the wire guide sleeve 400 may then be disengaged from theprotection sleeve 30 by radially compressing the flange 402 to disengagethe locking feature, and may be slipped off the free end 604 of theguide wire 600. A drill 500 having a cannulation 502 may be placed overthe free end 604 of the guide wire 14 and inserted into the bore 336 ofthe protection sleeve 30. The drill 500 may be advanced through theprotection sleeve 30 until the tip 504 contacts bone and then may berotated to drill the desired hole in the bone. Once the bone hole hasbeen formed, the drill 500 and protection sleeve 30 may then be removedfrom the incision. The guide wire 600 may be removed or it may be leftin place to be used as part of a subsequent procedure.

To use the combination of the protection sleeve 30/wire guide sleeve 400for installing a helical blade, the surgeon may undertake the same stepsas described above, with the exception that instead of removing theprotection sleeve 30 and guide wire 600 after the hole has been drilled,the surgeon may retain both elements in place and remove only the drillbit 500. Thereafter, a cannulated helical blade or spiral blade may beslipped over the free end 604 of the guide wire and inserted into thebore 336 of the protection sleeve 30. A cannulated driving tool mayfollow the helical or spriral blade over the guide wire 600 and may beused to drive the blade into to the hole in the bone.

The protection sleeve 30, drill sleeve 20, wire guide sleeve 400, trocar10 and any or all of the other described instruments may be provided aspart of an orthopedic kit for use during surgical procedures in whichpercutaneous placement of fasteners will be performed. Thus, the kit maycomprise one or more device, and each device may comprise a trocar,drill sleeve, and protection sleeve sized to correspond to a differentscrew size. Likewise, if the kit includes a wire guide sleeve 400, it aswell as the trocar and protection sleeve may be sized to correspond todifferent nail or spiral/helical blade sizes.

In an exemplary embodiment for use with an intramedullary nail, the kitmay contain three separate devices sized to correspond to screw sizes of3.2 mm, 4.0 mm and 5.0 mm, respectively. Other device sizes may beprovided as desired.

The trocar 10, drill sleeve 20, wire guide sleeve 400 and protectionsleeve 30 may be made of stainless steel, titanium, polymer or any otherappropriate material. In one embodiment, the trocar, drill sleeve andprotection sleeve are manufactured from a martinsitic stainless steel.

The trocar 10, drill sleeve 20, wire guide sleeve 400 and protectionsleeve 30 also may be manufactured from a radiolucent or partiallyradiolucent materials such as ultra high molecular weight polyethylene(UHMWPE), poly-ether-ether-ketone (PEEK), extruded carbon fiber or othersuch material. Any or all of the components of the system may also bedisposable.

It will be appreciated that although the invention has been described inrelation to its use with an intramedullary nail system, that theinvention may be applied to any orthopedic application in which astabilizing device, such as a bone plate, rod, nail, etc., is to beapplied to a bone. Thus, the invention may find application inmaxillofacial indications where small-sized plates are applied toportions of the cranio-facial skeleton and where screw sizes may be assmall as 1.0 mm. Likewise, the invention may be used in large-scaleapplications, accepting up to 17 mm drills used for installation ofspiral blades, helical blades, or for facilitating opening the insertionsite for an intramedullary nail.

1. An orthopedic system comprising: a first sleeve member having anouter surface and an inner surface defining a longitudinal bore and asurface; a second sleeve member having an outer surface and an innersurface defining a longitudinal bore, the second sleeve member furtherconfigured to be at least partly received within the bore of the firstsleeve member; wherein the longitudinal bore of one of the first andsecond sleeves is configured to receive a drill bit therethrough todrill a hole in bone, and wherein one of the first and second sleevemembers further comprises a protrusion and the other comprises acorresponding recess, the protrusion and recess being co-operable toprovisionally axially lock the first and second sleeve members togetherwhen the second sleeve member is at least partly received within thebore of the first sleeve member, the second sleeve being dis-engageablefrom the first sleeve through the application of an axial separationforce between the first and second sleeves and a radial compressionforce to at least a portion of the second sleeve.
 2. The system of claim1, further comprising a trocar configured to be received within thelongitudinal bore of the second sleeve.
 3. The system of claim 2, thefirst and second sleeve members further each having a proximal endcomprising a flange member and a distal end comprising a tapered tipregion.
 4. The system of claim 3, the longitudinal bore of the firstsleeve further configured to receive a driver and bone fastenertherethrough to allow insertion of the fastener into bone in a directionalong the longitudinal axis of the bore.
 5. The system of claim 4, thetapered tip of at least one of the first or second sleeve membersconfigured to align with a fastener hole in a bone fixation element. 6.The system of claim 5, wherein the bone fixation element is a bone plateor an intramedullary nail.
 7. The system of claim 1, wherein theprotrusion is integrally formed with the associated sleeve.
 8. Thesystem of claim 7, wherein the protrusion comprises at least onecircumferential ridge.
 9. The system of claim 8, wherein the recesscomprises at least one circumferential groove corresponding to the atleast one ridge.
 10. The system of claim 9, wherein the protrusioncomprises first and second tapered surfaces.
 11. The system of claim 9,wherein the second sleeve comprises at least one longitudinal slotdisposed between the inner and outer surfaces of the sleeve, the slotrunning from at least one end of the sleeve and having a length, theslot further configured to render at least a portion of the sleeveradially flexible.
 12. The system of claim 11, wherein the at least oneslot divides a first end of the sleeve into first and second halves,wherein pressing the first and second halves toward each otherdisengages the ridge from the recess, thereby allowing the first andsecond sleeves to be axially engaged with, or disengaged from, eachother.
 13. The system of claim 11, wherein the second sleeve has twolongitudinal slots diametrically disposed with respect to each otherabout the circumference of the sleeve.
 14. The system of claim 8,wherein the protrusion comprises at least one tapered surface configuredto facilitate radial compression of the second sleeve when the sleeve isinserted into the bore of the first sleeve.
 15. The system of claim 14,wherein the first and second sleeves and the trocar are color coded toprovide a visual indication of the size of a bone screw that can bereceived through the bore of the first sleeve.
 16. The system of claim1, wherein the outer surface of the first sleeve is configured to bereceived within the bore of an aiming arm of an intramedullary nail toalign the sleeve with a targeted fastener hole in a portion of theintramedullary nail.
 17. An orthopedic system comprising: a first sleevehaving proximal and distal ends, a longitudinal axis and inner and outersurfaces; a second sleeve having proximal and distal ends, alongitudinal axis, and inner and outer surfaces, the inner surfaceconfigured to receive at least a portion of the first sleeve, the innersurface further configured to receive a bone fastener and driver forinserting the fastener into the hole drilled in bone; wherein the innersurface of at least one of the first and second sleeves is configured toreceive a drill bit for drilling a hole in bone; and wherein at least aportion of the first sleeve is slidably receivable within at least aportion of the second sleeve; and wherein one of the second sleeve innersurface and the first sleeve outer surface comprises a protrusion, andthe other comprises a corresponding recess so that when the first sleeveis received within the second sleeve, the protrusion and recesscooperate to releasably axially engage the first sleeve with the secondsleeve; the sleeves being disengageable from each other by applying anaxial separation force between the first and second sleeves and a radialcompression force to at least a portion of the first sleeve.
 18. Thesystem of claim 17, further comprising a trocar configured to bereceived within the longitudinal bore of the first sleeve.
 19. Thesystem of claim 18, the sleeves further each have a proximal endcomprising a flange member and a distal end comprising a tapered tipregion.
 20. The system of claim 19, the tapered tip of at least one ofthe first or second sleeves being configured to align with a fastenerhole in a bone fixation element.
 21. The system of claim 20, wherein thebone fixation element is a bone plate or an intramedullary nail.
 22. Thesystem of claim 21, wherein the protrusion is integrally formed with theassociated sleeve.
 23. The system of claim 21, wherein the protrusioncomprises a plurality of discrete protruding elements.
 24. The system ofclaim 17, wherein the protrusion comprises at least one circumferentialridge.
 25. The system of claim 24, wherein the recess comprises at leastone circumferential groove corresponding to the at least one ridge. 26.The system of claim 25, wherein the protrusion comprises first andsecond tapered surfaces configured to engage a portion of the innersurface of the second sleeve.
 27. The system of claim 26, wherein thefirst sleeve comprises at least one longitudinal slot disposed betweenthe inner and outer surfaces of the sleeve, the slot running from atleast one end of the sleeve and having a length, the slot furtherconfigured to render at least a portion of the sleeve radially flexible.28. The system of claim 27, wherein the at least one slot divides afirst end of the first sleeve into first and second halves, wherein whenthe first sleeve is fully received within the second sleeve, pressingthe first and second halves toward each other disengages the ridge fromthe recess, thereby allowing the first sleeve to be removed from thesecond sleeve.
 29. The system of claim 28, wherein when the first sleeveis inserted into the second sleeve, the first tapered surface cooperateswith the inner surface of the second sleeve to radially compress thefirst and second halves together.
 30. The system of claim 27, whereinthe first sleeve has two longitudinal slots diametrically disposed withrespect to each other about the circumference of the sleeve.
 31. Thesystem of claim 30, wherein the protrusion comprises at least onetapered surface configured to facilitate radial compression of the firstsleeve when the sleeve is inserted into the bore of the second sleeve.32. The system of claim 31, wherein the first and second sleeves and thetrocar are color coded to provide a visual indication of the size of abone screw that can be received through the bore of the first sleeve.33. The system of claim 17, wherein the outer surface of the firstsleeve is configured to be received within the bore of an aiming arm ofan intramedullary nail to align the sleeve with a targeted fastener holein a portion of the intramedullary nail.
 34. A method of drilling a holein bone, comprising: (a) providing a drill sleeve and protection sleevecombination, the drill sleeve telescopically receivable within at leasta portion of the protection sleeve, the drill sleeve having an innersurface for receiving a drill bit for drilling a hole in a bone, thedrill sleeve having an outer surface comprising one of a protrusion anda recess configured to engage a corresponding recess or protrusiondisposed on an inner surface of the protection sleeve to provisionallyaxially lock the sleeves together; wherein the drill and protectionsleeve are separable from each other through the application of an axialseparation force between the sleeves and a radial compression force toat least a portion of the drill sleeve; (b) advancing the drill sleeveand protection sleeve combination through an incision in a patient; (c)advancing the drill sleeve and protection sleeve to align with a bonefixation element overlying a portion of the bone; (d) inserting a drillbit through the drill sleeve and advancing the drill bit to engage bone;(e) rotating the drill to produce a hole in the bone; (f) removing thedrill bit from the drill sleeve; and (g) applying an axial separationforce between the drill sleeve and the protection sleeve and applying aradial compression force to a portion of the drill sleeve to disengagethe two.
 35. The method of claim 34, wherein the drill sleeve andprotection sleeve further comprise a trocar configured to be receivedwithin the longitudinal bore of the drill sleeve.
 36. The method ofclaim 35, wherein the sleeves further each have a proximal endcomprising a flange member and a distal end comprising a tapered tipregion.
 37. The method of claim 34, wherein the bone fixation element isa bone plate or an intramedullary nail.
 38. The method of claim 34,wherein the protrusion is integrally formed with the associated sleeve.39. The method of claim 34, wherein the protrusion comprises a pluralityof discrete protruding elements.
 40. The method of claim 34, wherein theprotrusion comprises at least one circumferential ridge.
 41. The methodof claim 40, wherein the recess comprises at least one circumferentialgroove corresponding to the at least one ridge.
 42. The method of claim41, wherein the protrusion comprises first and second tapered surfacesconfigured to engage a portion of the recess.
 43. The method of claim42, wherein the drill sleeve comprises at least one longitudinal slotdisposed between the inner and outer surfaces of the sleeve, the slotrunning from at least one end of the sleeve and having a length, theslot further configured to render at least a portion of the sleeveradially flexible.
 44. The method of claim 43, wherein the at least oneslot divides a first end of the drill sleeve into first and secondhalves, wherein when the drill sleeve is fully received within the screwinsertion sleeve, pressing the first and second halves toward each otherdisengages the protrusion from the recess, thereby allowing the drillsleeve to be removed from the screw insertion sleeve.
 45. The method ofclaim 34, further comprising the steps of: (g) inserting a bone fastenerand screwdriver through the protections sleeve; and (h) driving the bonefastener into the hole in the bone to fix the bone fixation element tothe bone.
 46. The method of claim 34, further comprising the step,between steps (a) and (b), of: inserting the outer surface of theprotection sleeve into a bore in an aiming arm attached to anintramedullary nail; step (c) comprises advancing the protection sleeveand drill sleeve through the bore in the aiming arm to align with afastener hole in the bone fixation element; and step (e) comprisesdrilling a hole in the bone through the fastener hole in theintramedullary nail.
 47. The method of claim 46, further comprising thesteps of: (h) inserting a bone fastener and screwdriver through theprotection sleeve; and (i) driving the bone fastener into the hole inthe bone to fix the bone fixation element to the bone; and removing theprotection sleeve from the patient.